As I’m cleared through the daunting security desk, I wonder what goes on in the University of Toronto Centre for the Study of Pain (UTCSP). Inside there are no latex gloves scattered in corridors, no smell of antiseptic, no sound of drills buzzing through the hallway. Relieved, I make my way upstairs. For a place where pain is the name of the game, it’s not so scary after all.The UTCSP was founded in 1999 in an effort to bring together the large number of pain researchers working in Toronto. It began when five scientists combined forces to operationally function as a centre, and has since grown to include over 60 faculty researchers from U of T and affiliated hospitals.“There’s a real Canadian history to pain research,” says the centre’s director, Dr. Mike Salter. Some of the world’s foremost scientists in pain include McGill psychologist Ronald Melzack, and psychiatrist Harold Merskey from the University of Western Ontario. Their pioneering work has helped put Canada on the map since the early days of pain research.Since then, developments in the study of pain have led to a collaborative outlook on how to conduct research in the field. “People were realizing that in order to treat pain effectively, you need to have multiple approaches, and we’ve kept that going here,” says Salter.The UTCSP is a collaborative project involving the Faculties of Dentistry, Medicine, Nursing, and Pharmacy. According to Salter, “In terms of an academic pain centre that integrates different faculties, there really aren’t any others that do things the way that we do.”With a mandate of research and education, the UTCSP aims to lead to a better understanding of the mechanisms of pain and its alleviation, and to spread and apply new knowledge.On the research side, the centre facilitates projects, and helps faculty gain access to funding. It emphasizes an approach to clinical research from multiple angles in a number of disciplines.The centre’s focus on education has led to the development of programs to instruct undergraduates, graduates, and post-graduates in pain assessment and management. The UTCSP’s flagship program, the Interfaculty Pain Curriculum (formally known as Pain Week), is a weeklong intensive course in pain for undergraduate students in various health disciplines. The program has been very successful, and has included 884 students across faculties.In light of the centre’s educational mission: what exactly is pain? According to Salter, “there are two very distinct aspects that people often get confused: there’s pain, and there’s something called nociception.”Nociception is the unconscious detection of potentially tissue-damaging stimuli by the body’s central and peripheral nervous system. It can result from heat, chemicals, or noxious mechanical stimulation, like pinching.“There’s a really good survival value to be able to detect when the integrity of your body is being impaired somehow,” says Salter. “It’s really important to be able to do that.”But pain is not that.Pain is a function of the brain, and unlike nociception, it’s a conscious experience. It involves the integrated activity of various parts of the brain. Its relationship with nociception can be a tricky one. Nociception or noxious stimuli usually cause pain, but the stimulus is not always proportional to the discomfort experienced. Sometimes, pain can even occur without stimuli.“Where things get a little bit more confused is in situations of chronic pain, where the relationship between tissue damage and the experience that you have is quite variable,” says Salter. In cases like these, minor tissue damage can lead to a big experience of pain, or vice versa.According to Salter, understanding the nature of pain mechanisms is crucial, considering the huge role that pain plays in everyday life. “Most people outside the field think of pain as a symptom of a disease. But what we’ve come to realize in the field, and with huge amounts of evidence, is that pain is in the brain. But the brain is changed by pain. Or the brain changes pain. So we’re coming to see pain as a series of disorders of the nervous system.“That’s been one of the things we’re trying to educate people about: that pain isn’t just a symptom of diseases. Pain can be a disease in and of itself, and there are many people that suffer from it.”Statistics show that 10 to 20 per cent of the population suffers from chronic pain. All too often, people are afraid to talk about their pain problems because they don’t want to be stigmatized, or seen as complainers.For many pain conditions, there are not very many good therapies, which is why pain is both a major societal and health problem. These problems promise to continue to grow in magnitude because there is a disproportionate representation of pain as people get older. “Unless we do something about it,” says Salter, “pain problems are going to increase with the aging population.”In light of the challenges facing pain management today, the UTCSP aims to continue facilitating pain research, and to move beyond undergraduate professional education into more translational education for post-graduates, professionals, and continuing medical education. An increased understanding of pain as an economic, ethical, and human problem will also help to establish pain as an important focus for research worldwide.
The pain game
The unexpected consequences of minor head trauma
The 45-year old actress arrived at the resort on a Sunday, and hired an instructor on Monday for a private ski lesson. According to Mont Tremblant spokesperson Catherine Lacasse, she was not wearing a helmet. Richardson fell onto slushy snow, and did not collide with anything or suffer any signs of cuts or injuries. She picked herself up almost immediately and was not placed on a stretcher. The staff followed strict procedures, bringing her down to the bottom of the slope and back to her hotel, insisting that she should see a doctor. Richardson maintained she was okay. “She was joking and laughing,” Lacasse said.About an hour after the incident, complaining of a headache, Richardson was brought to the Centre Hospitalier Laurentien in Ste-Agathe, and transferred to the intensive care unit of Hôpital du Sacre-Coeur in Montreal. She spent fewer than 24 hours there before being flown to Lenox Hill Hospital in New York, during which TMZ reported her to be unconscious. Brain-dead by Tuesday night, she was taken off of life support the next day.According to the New York City medical examiner’s office, Natasha Richardson died from an epidural hematoma, a type of traumatic brain injury (TBI) that is commonly caused by a blow to the head. It occurs when blood builds up between the skull and the tough, leathery outer membrane of the brain, called the dura mater. Even in absence of a visible external injury, force from a blunt impact to the head makes the brain bounce within its cavity, causing surrounding blood vessels to tear. The resulting blood clotting between the dura mater and the skull reduces the space normally occupied by the brain, which is compressed from the gradual increase in pressure. This explains why Richardson initially seemed fine, but the effects of the impact escalated within such short duration.Had she agreed to see a doctor immediately after the incident, it would have increased her probability of survival. One week after Richardson’s death, a seven-year old Ohio girl’s life was spared when, after being hit in the head with a baseball, her parents recognized Richardson’s symptoms, and sent their daughter into the operating room in time to save her life.At least two million head injuries occur in the United States every year, and about 500,000 of these are serious enough for the emergency room. A hit to the head is no laughing matter.
Budget funds fall short of expectations
Ontario will give Ontario colleges and universities $780 million in capital funding over the next two years, the province announced in its budget last week. The money will pay for infrastructure costs, including updating older facilities and building new ones.The government has also promised a one-time $150-million cash relief injection to help postsecondary schools cope with immediate financial strains resulting from the recession.Despite the capital funding, U of T still faces significant operational expenses, said university spokesperson Rob Steiner. The costs include supporting research, and updating and expanding campus facilities.“[The $780 million commitment] is not the kind of funding that helps operate the university any better, but it gives us a better physical plan in which to do it,” said Steiner. “We’re going to have to make sure that over time we also have the support to actually operate those facilities we’re building now”Dave Scrivener, U of T Students Union VP external, said the payouts aren’t nearly enough to make a significant difference. “To put the $150 million in perspective: the Faculty of Arts & Science at U of T has a $48 million deficit, it alone would need one-third of the money to bring it even,” said Scrivener. “Spread this $150 million over 17 universities and 24 colleges, and it’s far too little spread over a large area.” “The current financial situation U of T finds itself in comes out of structural problems, where public universities are forced to rely on the stock market over public investment,” added Srivener.The 2009 budget has also committed $35 million for medical infrastructure and will create 100 medical school spaces across the province. Another $10 million will be used to expand graduate fellowships.With government resources stretched, U of T is looking at increasing tuition. Steiner said an increase would likely be in the single digits, and that a significant amount of the revenue from a tuition increase would go back into student aid.The budget has been criticized for failing to address student debt and financial assistance.“This is by far the greatest down fall of the budget; that there are no tangible benefits to helping students financially,” said Scrivener. “It’s all focused towards institutions.” “Ontario students have the fastest rising tuition fees, rising ancillary fees and are facing major enrollment pressures. We’ll need a balance of institutional funding and grants, as well as grants and tuition relief going directly to students, to effectively weather the recession.”
Fringe Science: The near death experience
You remember being knocked off your bike by an oncoming bus, but wonder why you are looking at the crash scene from atop a neighboring building. You notice your body lying motionless as paramedics’ race to your side. Your surroundings dim as the brightness of the sun begins to envelope your entire being and a sense of peace and oneness ensues, when suddenly pain washes over your body. A paramedic explains to you that you had been clinically dead for over five minutes. You have just had a near death experience.While this event may sound spooky, research suggests that as many as 10 per cent of cardiac arrest survivors report similar experiences.The controversy arises when an individual claims such an incident “proves” the existence of an after life, or that consciousness can exist irrespective of the body. By suggesting such things, one challenges the empirically well-founded assumption that the mind requires the brain to exist.For the past few decades, the conventional scientific explanation for near-death experiences has proposed that when individuals approach the moment of death, their brain starts to malfunction, causing hallucination-like experiences via the abnormal release of various neurochemicals. Recently, some researchers have called into question the validity of the “hallucination” hypothesis.In 2001, Dr. Sam Parnia and Peter Fenwick from the Southampton General Hospital in the UK conducted a large-scale review of literature on near death experiences. Published in the medical journal Resuscitation, their article argued, via the invocation of physiology research, that it is unlikely that biologically-mediated hallucinations occur following clinical death. Their research states that following cessation of the heartbeat, the brain ceases to function within around 10 seconds. This has been measured in various studies involving animals and humans.Without brain function, the cascade of neurochemicals hypothesized to be released could not translate into near death experiences, as the brain cannot mediate experiences under such deteriorated conditions. Nevertheless, near-death experiences are recalled by patients as occurring over the time period in which they are clinically dead. Furthermore, Drs. Parnia and Fenwick noted anecdotal stories in which patients perceived themselves as floating above their clinically dead bodies in the emergency room, and upon being revived, were able to remember specific details of the time in which they were “dead.” During an interview for Skeptiko in 2008, Dr. Fenwick noted a case in which an individual was in cardiac arrest and had an EEG connected to his head that showed no brain activity. Upon being revived, the individual accurately recalled and verified specific details of the procedure, claiming he saw the whole thing from the ceiling above. As such near-death experiences are noted for both their clarity and cohesiveness, questions remain as to why individuals with no brain activity are still capable of perception and cognition.At first glance, these anecdotal stories, in conjunction with the physiological research suggest the mind or “soul” may be capable of existing irrespective of the brain. But studies into near-death experiences have limitations. For example, numerous after-the-fact anecdotal stories cannot be substituted for true science and well-structured experiments. To claim that a clinically dead individual maintains existence outside of their body, one would need a way to verify this is not a near-death illusion.In 2008, a new five-year large-scale study was initiated, involving 25 hospitals worldwide, and 1500 patients. The participating hospitals place images and objects only viewable from a top-down ceiling perspective, to see if clinically dead individuals are actually separating from their bodies and floating to the ceiling. They would be expected to see these images, and be able to report them if revived. As the results of this study will not be published until 2013, answers to the question of the existence of the soul and the after life will need to wait.
$1.3 billion down the tubes
The University of Toronto’s aggressive investment policies have come under fire after its $5.5-billion endowment and pension fund posted a 30 per cent shrinkage for 2008.The university announced a $1.3-billion loss on its assets on Tuesday—a 29.5 per cent drop in pension funds and 29.4 per cent in endowments. The losses are worse than the average 18 per cent decline in large pension funds, reported the Globe and Mail.U of T Asset Management Corporation, an independent subsidiary in charge of the university’s assets, says that it expects to stick with current risk management practices.“A major change in strategy right now would be like locking the barn door after the horses have gone,” said U of T’s VP business affairs Catherine Riggall. “The University is a very long-term investor and we expect that there will be periods when markets are down. Over the five year period 2003-2007 the compound average result was 11.5 per cent—well above our target return of 4 per cent plus inflation.”“Unfortunately, the severity of the one-year results completely eliminated the strong out-performance that had been achieved over the previous five years,” said a communication from the university.This isn’t the first time U of T’s stocks have taken a hit since UTAM was established in 2000, bringing in a similar investment model to major U.S. schools like Princeton and Harvard. In 2002, the assets plunged by $320 million. At the time, UTAM cited the downtown in global equity markets.“The UTAM board has discussed the various views on the benefits and downsides of currency hedging and has recently moved back to a 50-per-cent hedged policy,” Riggall said. Though this represents a return to slightly more conservative investment policies, she said it is likely that previous positions will return as risk becomes more manageable.Endowment payouts, previously expected to contribute $62 million next year to scholarships, aid, bursaries, and endowed programs, have already been slashed. Commenting on whether the endowment losses would have a major effect on students, Riggall said, “Income from the endowment is a very small percentage of the total revenue of the university. The commitments to access and student aid remain in place and will be met.”
Marlie and me
He played four years with the Ontario Hockey League’s St. Michael’s Majors and failed to catch the attention of NHL scouts. Like many others who had followed the same road, Darryl Boyce was left with two choices. He could choose hockey, and play in the low minor professional ranks that dot the southern United States, or he could choose an education, and put himself through the rigours of post-secondary school in Canada.Like so many other young hockey hopefuls in Canada, Boyce dreamt of the opportunity to get drafted and play in the NHL. Boyce sacrificed the comforts of his small hometown life in Summerside, PEI to achieve it. He was drafted by the Majors in the OHL Amateur Draft, and at the age of 16, moved to Toronto to compete at the highest level of Canadian Junior hockey in the hope that someone would notice him.“It’s a shock,” said Boyce with a smile, remembering his first experience in the city. “All my friends were telling me that people get shot all the time, and it’s a huge city, and that I’ll never survive. It was overwhelming on my first day.”While Boyce would eventually get used to life in the city, it was not without its moments. “My roommate left me at the rink one day, and I never knew how the bus or transit system worked,” recalled Boyce with a sheepish grin. “So instead of jumping on a bus or asking for any directions I walked probably over ten kilometres home. I knew how he drove home, so I just walked the route home.”Boyce sacrificed a normal life to play hockey. But the scouts never noticed and the draft never came. His unspectacular numbers failed to draw eyes, and his quiet, hard-working mentality went unnoticed. He had slipped through the cracks of Junior hockey, and it seemed that his dream was drifting away.Hockey was important to Boyce, but so was his education. “It’s a big thing with my family. My mom and my dad don’t come from educational backgrounds, and they really push for me and my sister to get post-secondary education.”Fortunately for Boyce, the Majors offers a package to its players that stresses the importance of completing one’s education, operating in affiliation with the University of Toronto St. Michael’s College School. “It was a great honour for me to attend that school while I was here,” said Boyce. “U of T’s academics were phenomenal and they pushed education the whole way. They preached to us that academics were first. So if you needed to miss practice or a little bit of a practice you made sure that your schooling got done and that hockey came second.”In the end, Boyce would forgo professional hockey for the life of a student-athlete competing in Canadian Interuniversity Sports. Widely perceived as the proverbial dumping grounds for players who aren’t able to be professionals, it is one of the most under-scouted league in North America. An assumed lack of quality competition compared to that of Major Juniors has led to limited interest and very little attention from both hockey fans and the media.Nonetheless, hockey remained an integral part of Boyce’s choice of schools. “I wanted to get into a good hockey program, a winning organization,” said Boyce of his decision to go to the University of New Brunswick. “They had both. They had great organized sports teams and they had great academics. I got the best of both worlds at UNB. It was great.”Boyce credited his smooth transition to university life and work to his experience at St. Michael’s College School. “St. Mike’s was a great preparation for going to university. The workload at St. Mike’s was overwhelming at times. [At] University, you only take so many courses a day, and they’re spread out over the week. It really prepared me for what was to go on in university and I handled it quite well.”On the ice at UNB, Boyce blossomed, hitting an age of critical development as a hockey player that saw his size, speed, and strength improve dramatically. This sudden growth finally drew the eyes and ears of hockey scouts as he was named the Atlantic University Sport and CIS rookie of the year, leading the UNB Varsity Reds to a 15-8-1 record.He credited his Varsity Reds coach for his sudden growth. “Not too many people know that but me and my coach had it out [in my first year],” grinned Boyce. “One of the first games I got benched. We made our bus trip home to New Brunswick and I marched right back into his office and we had it out as to why I didn’t play. From then on in, we were pretty much straight shooters with each other and he gave me the ice time when I deserved and when I earned it.”“I sort of took the bull by the horns and ran with it that season.”His first season drew interest, even some talk. He used his second season to catapult his career. Boyle put his name on the scouting map with a strong offensive showing that cumulated to a gold medal in Italy, as well as the elusive National Championships in his second year with UNB.“[The Leafs and I] were in contact after the first year, but there was a lot of opportunity going back to UNB for my second year. We were going to be a contender for the Nationals and we had an All-Star team being picked from the Eastern Conference to go to Italy and represent Canada.”“And sure enough, it’s just like a fairy-tale story,” laughed Boyce. “I made the Italy team and represented Canada and won a gold medal in Italy. I came back, we made it to Nationals and we ended up winning the National Championships.”His hard work would earn him an AHL contract with the American Hockey League and Toronto Maple Leaf affiliate Toronto Marlies that summer, an offer that made Boyce choose between school and hockey once again. This time however, he chose hockey, though it wasn’t a decision he took lightly.“It was a really hard decision because my team the following year they went 26-1-1, went back to the championships. But as they say, ‘Been there, done that’ and you’ve got to move on to future endeavours.”For now, he is relishing the opportunities that helped move him forward in hockey, but the education that helped get him there hasn’t been discarded. “I just finished a marketing course from UNB here [in February],” said Boyce proudly. “I still pick away with it. More or less I want to do it for [my parents] and then I want to do it for myself. I want to achieve goals and that’s one of them.”Another goal is to play in the NHL one day. His hard work in the first half of the American League season in 2007-2008 saw him turn his AHL contract into a dream come true; an NHL deal with the Toronto Maple Leafs in December 2007.“I was fortunate to get the opportunity because not many players out of the CIS get even a chance at the American League level. I knew I had to come in and I had to earn a spot on the American league team, and sure enough my first half of the season was recognized by the management upstairs and they gave me a shot.”Boyce has already played his first NHL game January 24, 2008, which was unfortunately shortened by an injury during the game. Now he is waiting patiently for his next chance.“I relished the opportunity and unfortunately I got hurt in that first game. But I’m here and I’m knocking on the door again. I want to say I’m knocking on the door to crack the big club eventually. I’m just going to keep playing my hardest each and every game and hope that I get another chance to move.”“Burke and Wilson, and all the guys they brought in upstairs. David Nonis and Jeff Jackson and Mike Penny […] I could go on and on. They’re a great bunch of guys and further more than that they know their hockey. Ron Wilson coached a winning team in San Jose for the last six, seven years and Brian Burke won a Stanley Cup two years ago. I think the Leafs are heading in the right direction and people need to understand it is a turnover phase and guys are trying their hardest.”Boyle’s willing to wait, he’s already beaten the odds. He’s a former CIS player with an NHL contract and a chance to live the dream again.“You’re going to achieve your dreams if you work hard enough and I’m living proof of it.”
Who’s cashing in?
Ontario’s top-paid university employee is from U of T, and he’s not a professor.John Lyon made $557,474.36 in salaries and benefits last year, as managing director of private markets and co-chief investment officer at the U of T Asset Management Corporation.Lyon has come under fire for his high pay after UTAM-managed investments lost $1.3 billion in 2008, where pension and endowment funds lost a third of their value. Endowments are used to fund scholarships, grants, and bursaries.“UTAM compensation levels are set in relation to investment industry standards, since that is where our staff are drawn from,” wrote Lyon in an email to The Varsity. “My compensation in 2008 reflected performance results for 2007 and prior years, when UTAM outperformed. My 2009 compensation will reflect the 2008 results.”Lyon also noted that he received extra compensation last year for his additional role as interim CEO.Lyon’s earnings are followed by five presidents: McMaster, Waterloo, York, Guelph, and U of T’s David Naylor.The information was released March 31 as part of the Public Sector Salary Disclosure Act of 1996, under which the salary and tax benefits of all Ontario university employees upwards of $100,000 must be disclosed and published for the public.Last year, Naylor and then-vice-provost Cheryl Misak encouraged U of T staff to lower their salaries and expenses.Online analysts have been noting which university administrators are taking voluntary pay cuts. They’ve also noted that admins in Alberta make more than their Ontario counterparts, and that professors in business and medical fields dominate the pay scale.
Snow and tell
In order to prevent pushing and overcrowding, The Toronto Transit Commission places stickers on the inside doors of subway cars reading “Be Safe and Considerate.” While fourth-year Varsity Blues basketball player Nick Snow hails from London, Ontario, he lives near the Athletic Centre, and does not face a long commute to home games. For games at nearby Ryerson University, the basketball team doesn’t travel by bus, and instead are given the option of taking the subway. If the team were to ever come across the “Be Safe and Considerate” stickers on the way to a game, they might recognize that this description aptly befits Nick Snow and his approach to the game.The “safe” part of Snow’s approach has been documented before, but remains extremely compelling. Yet the “considerate” Nick Snow is rarely mentioned in print, but is an absolutely essential part of his character. From the first on-court interview, Snow is extremely personable and generous with his time. A gargantuan 6’7” power forward and centre, Snow is extremely honest, but quite humble, always praising his teammates. From this first interview, it is apparent that Snow is well brought up, and furthermore, his consideration extends beyond his inner circle.Standing against a wall along with his teammates prior to a playoff game against Queen’s, Snow offers up a friendly gesture of familiarity, and engages in a short chat. Afterwards, Snow wins the MVP of the game trophy. Many athletes are unapproachable before a game, but Snow seems to be motivated by knowing that others are cheering for him.During a later interview, Snow remains his gracious and considerate self. He sits patiently, answering a barrage of questions, long after he gulps down his hot chocolate. His enthusiasm never lags, and afterwards, he profusely offers his thanks. Snow is clearly focused in his desire to be a well-rounded player. When speaking of his game, Snow stresses the importance of striving to play smart.“I know how to play basketball,” said Snow. “I know when to shoot, when to pass, when to defend, when I need to score, how to get it, when I need to get a stop defensively, and when I need to foul. Those are the kinds of things that I learn through experience and can’t really be taught”.Snow is thrilled with his decision to come to the University of Toronto. “[U of T] is a good program, with a great coach, really good players, good people, it’s just a good situation to be in,” he said. “[The team] supports each other so much. A lot of teams would not be able to say that to each other. We communicate very well, [both on and off the court].”Snow is full of his praise for his coach, Mike Katz. “I talk to my coach a lot about becoming a complete basketball player, rather than just someone that can shoot very well.” Snow is most comfortable when leading by example, inspiring his teammates with his tremendous work ethic.He works harder than other players, and this is where the “safe” part of his personality comes into play. Snow has autoimmune hepatitis, a rare disease in which his immune system attacks his liver. Snow’s condition led to Stage IV scarring, causing an enlarged spleen. Doctors told Snow that he would never play basketball again, due to the damage that the game would cause to his spleen. But instead of giving up, Snow actually sped up his recovery. He helped to design a custom made spleen protector with the sports medicine clinic at U of T. Snow’s idea was to fashion a rugby ball as the main source of protection. He notices that he moves differently when wearing the device, but incorporates the differences into his game.While Snow shook off the suggestion that his medical condition has helped him to improve as a player, he emphatically stated that it helped him in another way. “[This experience] has helped enhance who I am as a person,” he reflected. “I used to sort of define myself as a basketball player. Now, I am thankful that I can play basketball, and that I am blessed with this one of a kind spleen protector. But at the same time, [basketball] does not define who I am. It is not a part of me. It is just something I do that I love to do.”Snow’s easygoing nature permeates his entire basketball experience. Oddly, Snow wears number 13 at home, and number 32 on the road. The reason? Someone lost his number 13 road jersey. As befitting his personality, Snow took this mishap in stride, and ran with it, now wearing both numbers. While basketball may not define Snow as a person, it shows his desire to work hard, and to be safe and considerate. “I am always striving to be a more complete basketball player […] It’s just a matter of improving all the things I need to improve.”